The COMSA initiative will enable a low-cost, sustainable, nationwide mortality surveillance system that tracks the under-five mortality rate and causes of death (COD) throughout Sierra Leone, linked to clinical-pathological confirmation on some under-five deaths. This will enable improvement in the understanding of the COD, and facilitate priority health interventions and informed strategy-setting. In turn, these will help Sierra Leone make faster progress toward achieving the United Nations Sustainable Development Goals (SDG). This investment is designed specifically to address “proof of concept” questions about linking large scale mortality surveillance to change in government priorities and linking community-based representative COD information to clinical-pathological data through the novel Minimally Invasive Tissue Sampling (MITS).
COMSA’s objective will be accomplished through four primary outcomes: (1) A cost-effective, high quality, low-cost and sustainable Sierra Leone Sample Registration System (SL-SRS) covering over 100,000 households, ~22,000 births, ~7,500 deaths for all age groups (including stillbirths), pregnancies and migration for 16 districts (using 1096 sampling units in all 190 chiefdoms). (2) Establish MITS clinical-pathological testing in about 200 under-five deaths and extend testing options. This MITS data will in turn be used to confirm verbal autopsy-based COD information. (3) Strengthen CRVS in the COMSA enumeration areas and integrate facility-based mortality reporting beginning in Bo District. (4) Integrate and report mortality data, with detailed geographical mapping, to wide audiences.